Provider Demographics
NPI:1811437726
Name:OPTIMA HEALTH, PSC
Entity type:Organization
Organization Name:OPTIMA HEALTH, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-283-4638
Mailing Address - Street 1:138 CAMPBELLSVILLE BYP
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8843
Mailing Address - Country:US
Mailing Address - Phone:270-283-4638
Mailing Address - Fax:270-283-4639
Practice Address - Street 1:138 CAMPBELLSVILLE BYP
Practice Address - Street 2:SUITE 5
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8843
Practice Address - Country:US
Practice Address - Phone:270-283-4638
Practice Address - Fax:270-283-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03286261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100193450Medicaid